Commentary on "Spiritual Experience and Psychopathology"

Abstract

Commentary on “Spiritual Experience and Psychopathology” Andrew Sims (bio) In examining this interesting paper, we need first of all to understand what the authors are doing. They are not taking the conceptual vehicles of “spiritual experience” (SE) and “psychotic phenomena” (PP) for a gentle outing, but exposing both of them to the hardest road test they can devise. From 1,000 accounts of “spiritual experiences” that were already so dramatic that those involved were prepared to describe them, the authors selected three which most successfully blurred the boundaries between SE and PP. So we are not exploring whether these concepts have general practical validity, but whether their mutual frontiers are discrete or overlapping. The authors’ task is legitimate, but it needs to be recognized for what it is. Unusual spiritual experiences are interpreted by the authors as psychotic symptoms, and the definitions of the Present State Examination (PSE) descriptions are cited to justify this. However, we have known for a long time that using instruments for purposes for which they were not designed can produce unexpected results; it is rather like washing socks in a dishwasher and being surprised that it does little good to the socks. The PSE was devised for categorizing and quantifying existing psychiatric disorders in epidemiological studies. The further one gets from this, its true purpose, the less satisfactory it becomes as an instrument. A better way of evaluating symptomatology in an individual case is a skilled and painstaking interview by a well-trained descriptive psychopathologist. One can only conclude from the authors’ use of the PSE in distinguishing SE from PP, that the instrument itself is not capable of doing this, which is not really very surprising. One can form no views on the concepts of SE and PP themselves, except that in some circumstances they may be difficult to tell apart. It would be easy to dispute whether Simon’s beliefs were delusions. Believers from many religious backgrounds “know” that God gives them thoughts or ideas, and it requires detailed psychopathological examination, and not the application of a questionnaire, to distinguish this from the much more concrete experience as described in PSE of “inserted thoughts.” Rating scales, be they assessments of the quality of teaching in primary schools or quantification of established psychotic symptoms, are necessarily only a pale reflection and an over-simplification of the skilled work that professionals undertake. To imply that because a score could be given on the PSE to an otherwise healthy woman who describes the frequent experience of hearing God’s voice, denies the validity of her experience, but also affronts the professional skills of a trained psychopathologist. When psychiatrists, or even [End Page 79] untrained research workers, use the PSE they are presumably doing so as part of an epidemiological research study, and the validity of their individual result is evened out by results from a number of other subjects. If a psychiatrist is trying to decide whether Sara had “true” hallucinations, he or she will carry out a psychopathological interview in which the criteria for establishing true hallucinations are much more sophisticated than is possible in a questionnaire, and the interview will be individualized. Sara’s significant statement, “but God doesn’t take your free will away,” immediately distinguishes her diagnosis from schizophrenia. It was good that Sara’s priest did not need detailed knowledge of psychopathology to come to a common-sense evaluation of her experience. It was with some feelings of disappointment that I realized that when the authors use the word “psychotic” they merely mean that a tick could be placed in an appropriate box for the PSE. If one were to carry out an investigation of serum electrolytes on a fit athlete on completion of a marathon, one would get bizarre and probably abnormal results. For a quantified investigation to be meaningful, one must always take account of the context. When I read these three cases as a psychopathologist, I find no convincing psychotic phenomena, and the three human beings were undoubtedly not psychotic at the time of expression of their religious experiences. The word psychosis is not helpful in psychopathology: if one looks more specifically in these cases for the phenomena...